The Bhutanese Leading the way.
Despite the introduction of Human immunodeficiency virus (HIV) prevention pill in the international market, the health ministry opts for ‘treatment as prevention strategy’.
The HIV pill is for people who are at high risk of sexually acquired HIV infections called pre-Exposure Prophylaxis (PrEP), which has the combination of two antiretroviral drugs namely tenofovir-emtricitabine (which is marketed as Truvada by Gilead)
It was approved by US Food and Drug Administration (FDA) on 19th July. This approval fell a few days before the Acquired immunodeficiency syndrome (AIDS) 2012 conference in 22nd till 27th of July in Washington, DC.
This drug is said to be made available only to individuals confirmed to be HIV negative at the time of prescribing.
A former health official, Dr. Tandi Dorji, who is presently the spokesperson of Druk Nyamrup Tshogpa (DNT), said this pill is the first of its kind and it is good news for Bhutan too.
“This pill is like any other contraceptive medicine. Unlike condoms, even if exposed a person can be free from transmission of viruses,” he added
But the cost of drug is said to be sky-rocketing. However he said though the cost is high at the moment but soon Bhutanese people can also afford it.
A heath official from Ministry of Health (MoH) who was also part of recent AIDS conference in Washington DC, Namgay Tshering said the pill contradicts the strategies of the MoH.
He said developing countries or underdeveloped countries in Africa and South East Asia are not ready to go for it and take an initiative to introduce this medicine.
“So we might possibly go for strategy rather than directly jumping into Truvada,” adding it being expensive, rather shared on the need to rationalize because of our country being a low HIV-prevalent country where not every individual are at risk of acquiring HIV infection.
For instance for out of ten thousand people, three people are infected which is considered very low.
The demographic status of the country shows almost 0.4mn between the ages of 15 to 64 years, the sexually active group.
“All the individuals will come and demand for the pill because they want to have sex without a condom,” said the health official.
Moreover he said it is not 100% guaranteed to prevent infection. “We are not sure about the clinical trials conducted by the company and its efficacy,” he added.
He said the strategy towards the prevention of infection and promoting the use of condoms, introduction of such thing means the whole scope of our initiatives will go in drain.
‘Treatment as the prevention’ was used as the key components in the conference that the country must adopt to control the spread of HIV.
“We will adopt on case by case basis,” Namgay Tshering said.
Success story was seen out of this strategy in most of the HIV epidemic countries in sub- Saharan Africa and in South East region in India and Thailand with remarkable decrease in the number of HIV incidences and achieved almost 10 to 20% reduction in HIV cases.
The health official said when countries with high concentration of HIV have good results; Bhutan can also move forward and achieve the Millennium Development Goals (MDGs) by 2015.
The new pill would also prove expensive, with the need to give medication to the entire HIV infected individuals while the National guidelines recommend treatment only to the people whose CD4 count (HIV infection) is less than 350 but the new strategy tells irrespective of this CD4 count, it has to given to all HIV infected individual.
In the cases of discordant couples where for instance one is positive and other negative, if a wife is negative, she has to take medication irrespective of positive or negative.
The health ministry official said it also has to undergo numerous procedures such as it has to be WHO pre-qualified, pros and cons of the medicine has to be discussed with National Drug Committee to introduce new medicine in the country and also the need to register with Drug Regulatory Authority (DRA) for the quality and efficacy.
“We are not really ready for this; it doesn’t mean we want to get our population infected with HI, rather we don’t want to take risks at this point of time,” said the MoH official.
Being a low HIV-prevalent country currently Bhutan’s target is on intervention programs with most risky groups of people such as sex workers, drug users, Men to Men sex (MSM), Transgender, mobile population and commercial drivers.
“We need to put resources to the right place for the right people” adding with the aim to eliminate mother to child transmission of HIV and to reduce the incidence of HIV in general public through more focused intervention programs.
Currently the ministry is in the process to improve the health care diagnostic facilities of all the hospitals. So every pregnant mother who comes for Anti-Neonatal check-up (ANC), has access to HIV testing.
Today there are about 225 people living with HIV, of which 71live on anti-retroviral therapy drugs.
Recent status of Bhutan as of June this year shows about 21 new cases of HIV, with the total number of detected cases of 291 including 25 children. It is said that more than 80% were cases of infection were acquired through heterosexually.
